Delayed appearance of Chlamydia trachomatis infections acquired at birth

Randomised equivalency trial comparing 2.5% povidone-iodine eye drops and ophthalmic chloramphenicol for preventing neonatal conjunctivitis in a trachoma endemic area in southern Mexico

AIM

To evaluate the effectiveness of 2.5% povidone-iodine eye drops (PIED) compared with ophthalmic chloramphenicol (OC) for preventing neonatal conjunctivitis.

METHODS

2004 neonates were enrolled from three rural hospitals in a trachoma endemic area. They were randomly assigned to receive either PIED (n = 1024) or OC (n = 974). Infectious conjunctivitis was confirmed by laboratory methods, including specific search for Chlamydia trachomatis by polymerase chain reaction assay.

RESULTS

During the first 48 hours after birth, PIED and OC had similar efficacy against bacterial conjunctivitis (95% confidence interval (CI), -0.031 to -0.004; p = 0.01); from day 3 to day 15, PIED was 6% less effective than OC (95% CI, -0.058 to -0.006; p = 0.01); after day 16 there was no significant difference between the groups (95% CI, -0.022 to 0.041; p = 0.57). However, the risk of C trachomatis conjunctivitis was increased in neonates receiving PIED prophylaxis (relative risk = 1.99 (95% CI, 1.07 to 3.71), log-rank p = 0.029). Ocular side effects were rare and self limiting in both groups (p = 0.223).

CONCLUSIONS

PIED seems to increase the risk of acquiring chlamydial conjunctivitis in neonates. Additional measures are required to prevent mother to fetus transmission of chlamydial infection during pregnancy, delivery, and after birth.

The importance of chlamydial infections in obstetrics and gynaecology: An update

Chlamydia is now the most common notifiable infectious disease in many countries, a fact that has serious ramifications for the reproductive health of women. This review highlights the epidemiology, pathophysiology, clinical features and reproductive sequelae of the infection. Current screening and management methods are outlined. Obstetricians and gynaecologists are ideally placed to play a major role in the primary prevention of this significant sexually transmitted infection.

High rates of Chlamydia trachomatis infections in young Papua New Guinean infants

OBJECTIVE

Determine the importance of Chlamydia trachomatis in the etiology of severe infection in young Papua New Guinean infants.

METHODS

Between March, 1991, and April, 1993, children <3 months old were recruited as outpatients at Goroka Base Hospital, Papua New Guinea, as part of a multicenter study in four developing countries. Children with predefined inclusion criteria were enrolled. C. trachomatis was identified by direct fluorescent antibody staining in nasopharyngeal aspirates (NPAs) collected from children with and without signs of severe disease and eye swabs from children with and without conjunctivitis. Two to three radiologists read chest radiographs without knowledge of clinical and laboratory findings.

RESULTS

Of 3280 outpatients seen 2168 enrolled, 955 NPAs were tested for C. trachomatis and 549 chest radiographs were read. Of 210 eye swabs from children with conjunctivitis 57% were positive for C. trachomatis compared with 8% from 167 children with no conjunctivitis. The prevalence of C. trachomatis in NPAs was 9% in asymptomatic children and 18 and 33% in children with nonsevere or severe pneumonia, respectively. C. trachomatis in NPAs was strongly associated with clinically severe pneumonia [odds ratio (OR), 2.91], reduced arterial oxygen saturation (OR 2.58) and radiographic evidence of pneumonia (OR 5.84) and was also associated with pneumococcal bacteremia (OR 3.48).

CONCLUSIONS

In Papua New Guinea Chlamydia must be considered as a cause when treating pneumonia in infants, and effective treatment and prevention of sexually transmitted diseases are urgently needed for a number of reasons, including the need to curb high rates of chlamydial infection in women and infants.

Perinatally acquired Chlamydia trachomatis associated morbidity in young infants

OBJECTIVE

This study was designed to evaluate the spectrum of morbidity associated with perinatally acquired Chlamydia trachomatis in infants < or =12 weeks of age, and to determine its relationship to maternal Chlamydia trachomatis status.

METHODS

DESIGN

Retrospective review of maternal and infant records.

SETTING

Large inner city teaching hospital.

PATIENTS

A cohort of 530 symptomatic infants < or =12 weeks of age who were tested for Chlamydia trachomatis infection in the upper respiratory tract during a 2-year period from January 1993 to December 1994.

RESULTS

During the study period, 70/530 (13.2%) patients tested positive for Chlamydia trachomatis from the conjunctiva and/or the nasopharynx. Complete medical records of 66 of these infants were available for review. Forty-eight of 66 (73%) infants had conjunctivitis, 13/66 (20%) had pneumonia, 5/66 (7%) had both conjunctivitis and pneumonia. Thirteen of 66 (20%) infants were hospitalized, 7 for pneumonia and 6 for ophthalmia, accounting for 68 hospital days. In 55/66 (83%), maternal records were available for review. Nineteen of 55 (35%) mothers had documented Chlamydia trachomatis infection at delivery or during pregnancy that had not been treated; 16/55 (29%) mothers tested negative for Chlamydia trachomatis sometime during pregnancy but were not retested at delivery, 8/55 (14%) were treated for Chlamydia trachomatis during pregnancy but status at delivery regarding reinfection was not evaluated. In 12/55 (22%) mothers, no prenatal testing was documented.

CONCLUSIONS

This study demonstrates significant morbidity in early infancy associated with perinatally acquired Chlamydia trachomatis infection. There is need for studies evaluating the importance of adequate maternal testing and treatment to reduce perinatal transmission.

Chlamydia trachomatis: an underestimated cause for rhinitis in neonates

The incidence of Chlamydia trachomatis genital tract infection among randomly selected attendants of the ante-natal clinic of the Suez Canal University Hospital, Ismailia, Egypt, during 1996 was detected. It was found to be 9% by examining endocervical swabs using the direct immunofluorescent test and 13% after serological detection by the indirect immunofluorescent test. The incidence of neonatal Chlamydia infection in the same population assessed by nasal and conjunctival swabs tested for Chlamydia using the direct immunofluorescent test was found to be 9%. In spite of the low incidence of neonatal Chlamydia infection detected in this study, neonates 'at risk' i.e. born to infected mothers, showed a high rate of Chlamydia transmission (57%) with 21.4% of the infected neonates presenting with this specific rhinitis. This study documents Chlamydia trachomatis as an underestimated cause of rhinitis in neonates characterized by being resistant to empirical remedies.

Anogenital skin diseases of childhood

Evaluation of anogenital lesions in children is a challenging problem. The differential diagnosis includes a spectrum of traumatic, infectious, neoplastic, and genetic disorders. The possibility of sexual abuse should always be considered and investigated as indicated. A systematic work-up will expedite the correct diagnosis and limit unnecessary anxiety for parents, children, and physicians. Referral to a center that provides specialized service for the evaluation and treatment of these disorders may be indicated.

Role of Ureaplasma urealyticum and Chlamydia trachomatis in development of bronchopulmonary dysplasia in very low birth weight infants

OBJECTIVE

To investigate the relationship between Ureaplasma urealyticum and Chlamydia trachomatis colonization of the very low birth weight infant and the development of bronchopulmonary dysplasia (BPD).

METHODS

Endotracheal and/or nasopharyngeal aspirates and clinical data were obtained prospectively from 108 infants with a birth weight of < 1501 g and analyzed for U. urealyticum and C. trachomatis by culture and polymerase chain reaction (PCR).

RESULTS

U. urealyticum was detected by culture in 40 (37%) infants and by PCR in 49 (45%) infants on at least one occasion. BPD was present at 28 days in 26 of 40 (65%) U. urealyticum culture-positive infants and 39 of 68 (57%) culture-negative infants (relative risk (RR) 1.13, 95% confidence interval 0.83 to 1.54; P = 0.538). BPD was present at 28 days in 34 of 49 (69%) U. urealyticum PCR-positive infants and in 31 of 59 (53%) PCR-negative infants (RR 1.32, 95% confidence interval 0.97 to 1.79; P = 0.135). At 36 weeks postconceptional age culture-positive or PCR-positive infants were at no greater risk of BPD than infants with negative results (RR = 1.02, P = 0.92 and RR = 1.2, P = 0.523, respectively). In addition the presence of U. urealyticum was not associated with any significant difference in the length of hospital stay, days of ventilation, days of oxygen supplementation, birth weight or gestational age. C. trachomatis was detected in only 2 infants.

CONCLUSION

C. trachomatis was found infrequently in the airways of premature very low birth weight infants. U. urealyticum was frequently detected but its presence was not significant with regard to development of BPD, duration of ventilatory support, oxygen dependency and length of hospital stay.

Current methods of laboratory diagnosis of Chlamydia trachomatis infections

Infections caused by Chlamydia trachomatis are probably the most common sexually transmitted diseases in the United States. Commonly unrecognized and often inadequately treated, chlamydial infections can ascend the reproductive tract and cause pelvic inflammatory disease, which often results in the devastating consequences of infertility, ectopic pregnancy, or chronic pelvic pain. C. trachomatis infections are also known to increase the risk for human immunodeficiency virus infection. The obligate intracellular life cycle of C. trachomatis has traditionally required laboratory diagnostic tests that are technically demanding, labor-intensive, expensive, and difficult to access. In spite of these historical challenges, however, laboratory diagnosis of C. trachomatis has been a rapidly advancing area in which there is presently a wide array of commercial diagnostic technologies, costs, manufacturers. This review describes and compares the diagnostic methods for C. trachomatis infection that are currently approved for use in the United States, including the newest DNA amplification technologies which are yet to be licensed for commercial use. Issues to consider in selecting a test for purposes of screening versus diagnosis based on prevalence, performance, legal, social, and cost issues are also discussed.

Risk of perinatal transmission of Chlamydia trachomatis by mode of delivery

We compared the transmission rate of Chlamydia trachomatis infection from infected women to their infants after various modes of delivery. After vaginal birth, Chlamydia trachomatis was isolated from 58 of 125 infants with a cephalic presentation, and serological evidence of chlamydial infection was found in another eight. C. trachomatis was isolated from the only infant with a frank breech presentation. After Caesarean birth, C. trachomatis was isolated from two of 10 infants born after rupture of the membranes and from one of six without prior rupture of the membranes. No serological evidence of infection was found in any of the culture-negative infants born by Caesarean section. By survival analysis, rates of transmission were significantly lower after Caesarean section with rupture of the membranes before delivery than after vaginal delivery. Infants born to infected women are at risk of C. trachomatis infection regardless of route of delivery.

Chlamydia trachomatis infection during pregnancy

Although transmission of Chlamydia trachomatis to infants during vaginal birth can result in conjunctivitis and pneumonitis, there is uncertainty about other adverse effects of chlamydial infection during pregnancy. There is some evidence that it may contribute to adverse complications such as premature rupture of membranes, preterm labor and birth, low birth weight, and still birth. Infection with C. trachomatis is also implicated in postabortal, postcesarean section, and postpartum maternal infections. Treatment of chlamydial infection during pregnancy has proved beneficial in the prevention of neonatal morbidity and is now recommended by the Centers for Disease Control.

Correlation of the percent of positive Chlamydia trachomatis direct fluorescent antibody detection tests with the adequacy of specimen collection

Chlamydia trachomatis is an obligate, intracellular parasite infecting the columnar and transitional cells lining the endocervix, uterus, fallopian tubes, rectum, urethra, and epididymis. We determined if the percent of specimens positive for C. trachomatis in the Microtrak Direct Specimen Test depended on the quality of specimens obtained. Female genital slides (649) were evaluated by the direct fluorescent antibody (DFA) test for the presence and numbers of (a) C. trachomatis elementary bodies and (b) columnar, transitional and squamous epithelial cells, and polymorphonuclear neutrophils (PMNs). Only 138 (21.3%) of the 649 slides were considered to be adequately taken, that is, containing columnar/transitional cells either alone or in conjunction with squamous cells and/or PMNs. Of the 138 adequate slides, 10 (7.2%) were C. trachomatis positive. However, 511 (78.7%) of the 649 slides were judged inadequate; 395 contained only squamous cells and/or PMNs, 19 were too thick to determine cell types, 46 contained only cell debris, and 51 contained neither cells nor debris. Only four (0.78%) of 511 were C. trachomatis positive. Thus adequate specimens containing columnar/transitional cells for C. trachomatis detection had a tenfold increase in the percent of positive results compared to inadequately collected specimens. By using the DFA test, one has the advantage of determining the adequacy of the specimens obtained as well as the presence of chlamydiae.

Perinatal transmission of Chlamydia trachomatis. The use of serological tests in detecting infected women

A study is presented on the use of serological tests for the detection of Chlamydia trachomatis in 273 pregnant women. 166 were cultured for C. trachomatis and nine (5.4%) were positive. Three culture-positive babies, all born to culture-positive women, had conjunctivitis. Elevated IgG and IgA antibody levels were seen in six (67%) and three (33%) of the infected women, respectively. Three (2.4%) of IgG antibody-negative mothers (n = 126) were positive by culture. Compared to serology culture of the microorganism appears as the most reliable way of detecting infected women.

Chlamydia trachomatis infection in dizygotic twins delivered by caesarean section

Chlamydia trachomatis was isolated from the conjunctiva, pharynx, and rectum of one 10 day old twin delivered by caesarean section without prior rupture of the chorioamnion and from the pharynx of her brother. The means by which C trachomatis causes such infection is not known.